Surgical management of incidental asymptomatic contralateral inguinal hernias: a retrospective cohort study

Vollständiger Abstract

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Aim The management of asymptomatic contralateral inguinal hernias incidentally detected on preoperative imaging remains debated. This research evaluates surgical strategies and outcomes for individuals with incidental findings versus those with clinically symptomatic hernias. Methods A retrospective cohort study of 244 patients undergoing inguinal hernia repair from January 2022 to April 2025 at a tertiary care center was conducted. Patients were grouped into those with a symptomatic unilateral hernia and an incidental asymptomatic contralateral hernia (n = 42) and those with clinically symptomatic unilateral or bilateral hernias (n = 202). Outcomes included operative time, length of hospital stay, and postoperative recurrence. Non-parametric tests and multivariable regression were used. Results Of 42 patients with incidental contralateral hernias, 52.4% underwent unilateral repair, and 47.6% underwent bilateral repair. Operative time was longer in the incidental group (median 183 vs. 125 minutes, P < .001), with no significant difference in length of hospital stay (median 1 day, P = .96). No recurrences were observed. Multivariable analysis confirmed a longer operative time in the incidental group (adjusted ratio, 1.3; 95% CI, 1.1–1.5; P < .001). Conclusion Prophylactic repair of incidental contralateral hernias is common but increases operative time without affecting the length of hospital stay. This may reflect short follow-up duration, as the study period extended to April 2025, leaving recent surgeries with limited observation time. Literature suggests that 20–30% of asymptomatic hernias become symptomatic within 2–5 years, supporting prophylactic repair in some cases, particularly with laparoscopic techniques that minimize morbidity.